Cluster Headaches

What is a cluster headache?

A cluster headache is pain on one side of your head that lasts from 15 minutes up to three hours. The pain occurs daily for weeks to months, often happening at the same time each day and up to eight times per day. When you feel recurring cluster headache pain, it’s called an attack. After an attack, you may go months or even years before you experience another cluster headache.

Why are they called cluster headaches?

Cluster headaches get their name from how they affect you. They come on in clusters, or groups, before temporarily going away for most people.

How do cluster headaches differ from other types of headaches?

Within your life, you’ve probably experienced a headache before. There are two main types of headaches:

• Primary headaches: These start because of a response from the part of your brain that communicates pain. A primary headache is its own health challenge, not part of a larger issue.
• Secondary headaches: These start because of another health condition. Several things can cause these headaches, including ear infections, nasal congestion and dehydration.

A cluster headache is a type of primary headache. But not every headache is a cluster headache. It’s easy to mistake a cluster headache for the following types of headaches:

• Migraines: A migraine causes a throbbing, pulsing headache on one side of your head that gets worse with physical activity, lights, sounds or smells.
• Sinus headaches: A sinus headache feels like a dull pain behind your eyes, in your cheekbones, forehead or nose. It’s a symptom of sinus infections (sinusitis).
• Tension headaches: Tension headaches cause mild-to-moderate pain, which feels like a tight band around your head.

How common are cluster headaches?

Cluster headaches aren’t common. They affect an estimated 0.1% of people around the world. This equals about 1 out of every 100,000 people.

What are cluster headache symptoms?

Symptoms of cluster headaches happen on the same side of your head as the headache (unilateral) and include:

• Head pain.
• Watery eye.
• Eye redness.
• Droopy eyelid.
• A runny or stuffy nostril.
• Flushing or sweating.

The location of your head pain may vary. It happens on only one side (unilateral) and in one of the following regions:

• Orbital: Behind your eye or near your temple.
• Supraorbital: Above your eye, near your forehead.
• Temporal: Side of your head behind your ear.

Typically, you’ll have pain on the same side of your head during an attack cycle. While rare, it may switch locations during another attack. The most common location is around one eye to the side of your head at your hairline before your ear (temple).

Many people report that cluster headaches wake them up an hour or two after going to bed. They’re sometimes called alarm clock headaches for this reason. These nighttime headaches may feel more severe than those during the day.

When symptoms set in, it usually only takes five to 10 minutes for them to reach their worst.

What does a cluster headache feel like?

A cluster headache feels like a:

• Burning sensation.
• Sharp pain.
• Stabbing pain.

Some people who experience cluster headaches report that they feel restless during an attack. This feels like you can’t sit still and need to pace.

Are there warning signs of cluster headaches?

You may experience slight discomfort or a burning feeling on one side of your head just before a cluster headache. But cluster headaches often come on fast, so these signs don’t leave you much time to prepare.

How long do cluster headaches last?

On average, a cluster headache tends to last 30 minutes. You may experience up to eight of these headaches within 24 hours. Many have daily cluster headache attacks that last for three months.

Then, the clusters usually pause, for reasons that aren’t yet understood. The headaches go into remission (go away) for months or years before returning.

Some people never get much of a break, though. They experience chronic (ongoing) cluster headaches. This happens to about 1 in 5 people who get cluster headaches.

Cluster headaches are commonly seasonal. You might notice them in the fall and springtime the most.

What is the main cause of cluster headaches?

Healthcare providers don’t know the exact cause of cluster headaches. Research found that they could relate to your body releasing the following near the trigeminal nerve that sends sensations between your face and brain:

• A chemical that helps in allergic reaction response (histamine).
• A chemical that carries messages between nerve cells (serotonin).

In addition, research found that cluster headaches may happen if there’s dysfunction in the area of your brain called the hypothalamus.

Research also found that cluster headaches can be genetic in up to 5% of people. Studies are ongoing to learn more about the causes of cluster headaches.

What triggers cluster headaches?

A trigger is something that causes your symptoms to start. Triggers during a cluster headache cycle vary from person to person but may include:

• Tobacco, alcohol and other substance use.
• Bright lights.
• Hot temperatures.
• Nitrites in food (preserved meats).
• Certain medications (like sildenafil).

Triggers can also affect the start of a new cycle of attacks after a period of no symptoms. When headaches start, the shift may appear tied to changes in seasons. (You might think you have allergies or sinusitis). It may happen because of suspected ties between cluster headaches and the hypothalamus. This part of your brain contains your “circadian clock,” a built-in schedule that responds to sunlight. When seasons change, so does the amount of sunlight.

If you don’t know what triggers your symptoms, talk to a healthcare provider and keep a journal to help you identify them. In your journal, you can write down:

• When and for how long you had a headache.
• What foods or beverages you consumed the day before.
• What activities you participated in before the headache.
• How long and how well you slept the night before.
• If you took any medications to treat the headache once it started and if it was effective after.

What are the risk factors for cluster headaches?

You may be more at risk of cluster headaches if you:

• Are between age 20 and 40.
• Frequently drink alcohol.
• Take certain medications.
• Use tobacco products (cigarette smoking).

What are the complications of cluster headaches?

Cluster headaches can be an irritant that interferes with your daily routine, including your ability to complete personal obligations like work or school. You may not feel well enough to do the things you enjoy or even leave your home during an attack.

Having a severe headache every day can make you feel helpless like there’s no hope. While rare, you may develop depression that can lead to suicidal thoughts. Some people call cluster headaches “suicide headaches” for this reason. Luckily, you’re not alone. Healthcare providers can help you with these headaches. If you experience suicidal thoughts, contact (call or text) the Suicide and Crisis Lifeline at 988 (U.S.). Someone is available to help you 24/7.

How are cluster headaches diagnosed?

A healthcare provider (a neurologist) will diagnose a cluster headache after a physical exam. They’ll want to know more about your symptoms and your medical history. A provider may offer an imaging test, like an MRI, to rule out conditions with similar symptoms. If you’re experiencing attacks, it can help your provider learn more about your symptoms as they happen. Your provider might request an exam during the time when your headaches happen each day to observe how the headaches affect you.

What are cluster headache treatments?

Cluster headache treatment options may include:

• Medications to prevent headaches.
• Medications to manage pain during an attack.

If medications don’t help, your healthcare provider might suggest surgery. A surgeon may implant a neurostimulator device to send electrical signals to certain nerves in your head to manage your symptoms. Your provider will let you know if surgery is a good option.

Cluster headache medications

There are two types of medications that your provider might recommend for different reasons including:

• Prevention medications: Certain medications can shorten a headache cycle. They can also make the headaches less severe. Common medications may include those that treat allergies, depression, blood pressure and seizures. Also, galcanezumab is a U.S. Food and Drug Administration-approved preventive therapy that targets calcitonin gene-related peptide (CGRP) monoclonal antibodies.
• Pain management medications: When a headache occurs, certain medications may help with your symptoms, like triptan medicines (sumatriptan), anti-inflammatory medicines (steroids like prednisone) or dihydroergotamine injections (can’t be taken with sumatriptan). Breathing in 100% oxygen may help relieve symptoms during an attack.

Anti-inflammatory medications (NSAIDs like ibuprofen) aren’t effective medications to treat cluster headaches.

Alternative therapies for cluster headaches

Some alternative therapies may provide relief from cluster headaches, including:

• Acupuncture: Acupuncture uses small needles. A healthcare provider inserts needles into your skin at various points to relieve pain.
• Physiotherapy: Treatment focuses on stretching, moving joints and massaging techniques.
• Spinal manipulation: This chiropractic adjustment realigns your spine.
• gammaCore: An external vagus nerve stimulator (a portable, noninvasive neurostimulator).

Your healthcare provider may make alternative recommendations based on your situation. If you have questions or want to learn more, don’t hesitate to ask.

Can cluster headaches be prevented?

You can’t prevent cluster headaches entirely. You can identify and avoid triggers that cause symptoms, like smoking or drinking alcohol, which reduces your risk of an attack. Triggers vary from person to person, so what you need to avoid may be different for someone else.

If you have sleep apnea that’s related to your headaches, talk to a healthcare provider about managing that condition or any other underlying health conditions.

What’s the outlook for cluster headaches?

Cluster headaches don’t affect your life expectancy and they’re not life-threatening, but they can significantly impact how you feel each day. While cluster headaches are a chronic (long-term) condition, many studies found that these headaches become less frequent as you age.

How do I get rid of cluster headaches?

Unfortunately, there is no cure for cluster headaches. But you do have treatment options that can make them a little less painful or less frequent.

Your healthcare provider will work with you to develop an appropriate treatment plan. Make sure to follow your healthcare provider’s recommendations for the most effective relief.

When should I see a healthcare provider?

If you suspect you have cluster headaches, reach out to a healthcare provider to confirm the diagnosis. You don’t have to be in the midst of a cluster to see a specialist or get a diagnosis.

Contact a healthcare provider if you have headaches that:

• Change in severity.
• Are frequent or change in frequency.
• Don’t resolve with medication.
• Occur with a stiff neck or fever.
• Occur with speech, vision or movement problems.

Let your healthcare provider know if you become pregnant or are thinking about becoming pregnant and you’re taking medications for headaches.

If you have cluster headaches and take medications for them and you notice side effects or don’t feel like it’s effective anymore, let your provider know.

What questions should I ask my healthcare provider?

• What triggers my symptoms?
• Do I need to keep a journal to identify triggers?
• What type of treatment do you recommend?
• Are there side effects of treatment?
• Can you recommend any alternative therapies?
• When and how often should I take medication to treat an attack?
• Are there any herbal supplements or over-the-counter medications I can take to help alleviate my symptoms?